Gluten-free meals in public catering.

BACKGROUND: The Piedmont Region, the Food Hygiene and Nutrition Services of the Local Healthcare Authorities of the Piedmont Region (coordinated by ASL TO 3), and the Italian Coeliac Association Piedmont Onlus, have created a theoretical-practical training pathway for Food Business Operators to ensure a safe gluten-free meal. STUDY DESIGN: The aim of the study is to perform a retrospective analysis of the data collected in order to assess whether the Food Business Operators will be able to manage in the short, medium and long term audits (3-month audits, 6-month audits and 1-year audits) all the production stages of a gluten-free meal (storage, production. METHODS: We have analysed the check-list used for assessing the gluten free meal, recorded from 2010 to 2016 by the staff of the Food Hygiene and Nutrition Services. They were filled out during three educational audits and they refer to 81 facilities. RESULTS: Two-hundred and forty-three audits were conducted (3 per facility). During all stages of production of gluten-free meals (short, medium and long term), non-compliant aspects had decreased (not statistically significant). The data analysis showed a slight increase in non-compliant aspects after a 1-year storage, the trend of non-compliant aspects slightly decreased during the three production stages, the service stage registered a slight upward trend, and finally, during the basic requirements stage and control plan stage, non-compliant aspects were in sharp decline (statistically significant). CONCLUSIONS: The decrease of non-compliance guarantees safety and protection of the celiac subject, even if storage and services must be monitored more carefully in the medium term.

Platelet rich fibrin in the management of medication-related osteonecrosis of the jaw: a clinical and histopathological evaluation.

Bisphosphonates are antiresorptive pharmacological agents used in the treatment of osteoporosis. Recently, osteonecrosis of the jaw has been recognized as a potential side effect in patients on long-term bisphosphonate therapy. This condition, popularly called bisphosphonate-related osteonecrosis of the jaw (BRONJ), has been rechristened as MRONJ (medication-related osteonecrosis of the jaw) to accommodate the increasing number of cases of osteonecrosis of jaws associated with various other antiresorptive and antigiogenic pharmacological therapies. The aim of the present study was to assess the outcome of using platelet-rich fibrin (PRF) for the treatment of MRONJ in a single study group. Twenty-three consecutive patients (15 females and 8 males; aged 52-73 years) with MRONJ were enrolled in this study. These patients presented a history of bisphosphonate medication of varying duration, presence of exposed bone in the maxillofacial region for more than eight weeks, and no history of radiation therapy to the jaws. These patients were managed by surgical curettage and application of platelet rich fibrin (PRF). The outcomes were assessed using clinical and histopathological methods. On the basis of the present findings, we can conclude that PRF can act as an effective barrier membrane between the alveolar bone and the oral cavity and may offer a fast, easy and effective alternative method for the closure of bone exposure in MRONJ patients.

Prevention of healthcare associated infections: a descriptive study.

BACKGROUND: This study aims to verify whether there are, and to which degree, knowledge and adherence to guidelines on the prevention and control of healthcare associated infections by nursing staff. Study design. A descriptive study was conducted on a sample of nurses in the areas of medicine, surgery, and its own specialties of the Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico in Milan from 1st December 2015 to 29th February 2016. METHODS: The knowledge of the nursing staff have been investigated through the use of questionnaires with anonymous self-reporting method; inspections in the wards using observational grids were carried out in order to verify adherence to best-practice principles. The data collected concern, both for the knowledge and for the practice, the following macro-areas: a) Cleaning, disinfection and sterilization, b) Hand hygiene, c) Standard and isolation precautions, d) Prevention of catheter-related urinary tract infections, e) Prevention of catheter-related bacteremia, f) Prevention of surgical site infections, g) Prevention of respiratory tract infections. Statistical analyzes were performed using Microsoft Office Excel and STATA software. RESULTS: 245 nurses from 16 wards were involved. In each wards 4 inspections were conducted. 128 completed questionnaires were returned, all considered for the analysis of data; the adhesion was 52.2%. The participants achieved an overall score of 15.0 ± 4.1 (mean ± SD) on a maximum achievable score of 23 and >75% of them have reached a sufficient level. Among the most positive results, it must be underlined that nurses have demonstrated a higher level of knowledge for hand hygiene, with >81% correct answers; that the lumens of central venous catheters, when not in use, were kept covered with a protective cap in more than 99% of cases; that, for patients bearers of urinary catheter, the urinary drainage bag was maintained below the level of the bladder, as recommended, in more than 91% of the cases. On the contrary, as a very negative result, we found the greatest knowledge gap as regards cleaning, disinfection and sterilization, with a number of incorrect answers approaching 50%; furthermore, 64% of nurses wore jewels on their wrists, and / or hands when in action; finally, the alcohol-based handrub device could be easily reached from at least one of the beds of the room in less than 13% of the cases. CONCLUSION: Some knowledge gaps and differences with respect to adherence to best-practice principles for the prevention and control of healthcare associated infections was highlight by the present study.

Celiac disease and school food service in Piedmont Region: Evaluation of gluten-free meal.

INTRODUCTION: The Law 123/2005 recognizes celiac disease as a social disease and so Ministry of Public Health annually allocates specific resources to Regions for managing gluten-free meals in school canteens. Therefore in 2009 Piedmont Region approved a specific project, in collaboration with Food Hygiene and Nutrition Department (SIAN) of several ASL (Local Health Authority), including ASL TO3 as regional leader, and the "Italian Celiac Association - Piedmont and Valle d'Aosta". This project was intended to facilitate the natural integration of celiac people in social life. A retrospective analysis of data has been carried out to assess the management of gluten- free meal of school food services in Piedmont Region in 2010. Furthermore the intervention efficacy has been evaluated comparing the critical points observed in 2010 and 2012. METHODS: The object of the study includes primary and secondary schools that have provided gluten-free food service in Piedmont Region. These school were examined by SIAN staff. (the examination included the check of hygienic aspects and qualitative assessment of the meal). The data were collected using the same checklist throughout the region. All data were included in the unified regional system ("Reteunitaria"). RESULTS: The results show that 29% of the sampled schools (277) are acceptable in all eight sections (supply, storage, process analysis, equipment check, packaging and transport, distribution of meals, self-control plan and qualitative assessment), whereas 71% are inadequate for at least one of the profiles (60% does not perform the qualitative valuation of service) and in 18% of schools three to seven insufficiencies are observed. Correlations between the number of total insufficiencies and the most critical sections of the check list were performed (with lower scores in "good") such as process analysis, distribution of meals, self-control plan and qualitative assessment. The analysis process has achieved a high score in the field of deficiency for at least 3 parameters. Schools with a good self-control plan have a significant correlation with schools suitable for the analysis process, instead schools appeared insufficient in the process analysis have an increased chance of being insufficient also in the distribution of meals. The schools that provide a transported meal (municipalities highly populated, generally) have many differences in distribution of meals respect schools that prepare food in the school kitchen. In fact, 88% of school that provide a transported meal achieved an appropriate score in distribution of meals section and collected fewer failures in overall assessment than the others. 120 structures are included in the indirect comparison between the checklist's sections with criticisms, during years 2010 and 2012: in 2010 32% of schools were recorded acceptable in all of the eight sections of the checklist and in 2012 this percentage rose to 54%. An improvement can be observed in all areas, but a statistical significant result do not turn out. DISCUSSION AND CONCLUSIONS: Data show that carry on the control activities of production of gluten free meal in school canteens would be appropriate. Actions focused on improving the methods of preparing meal without gluten were recommended, especially in under populated municipalities with school kitchen on site. The constant presence of ASL staff in school has promoted important changes: cultural change and about the management of allergy and food intolerance. An improvement can be observed: a transition from a suspicion about "special diet" management to an appropriate and responsible management of meals for children and young people suffering from this specific condition.

Malignant pleural mesothelioma presenting with symptomatic brain metastases: report of a case.

We describe a unique case of brain metastases presenting as first symptom of a malignant mesothelioma (MM). MM is a highly aggressive tumor of the serous membrane that is generally believed to be rarely metastasizing. Recently, the reports of long surviving cases and larger literature reviews have suggested that cerebral metastases are not so uncommon. An extensive histochemical and immunohistochemical panel is needed to achieve a correct differential diagnosis, especially in the epithelioid type. Pathologists should be aware that brain metastases could have a mesothelial origin.

Macrophages and mast cells are involved in carotid plaque instability.

The aim of this study was to evaluate the role of macrophages and mast cells and of microvascular density in atherosclerotic plaques collected from 63 consecutive symptomatic and asymptomatic patients undergoing carotid endarterectomy for carotid disease. Results have shown no statistically significant differences between the two groups as concerns: (i) the degree of stenosis; (ii) the extention of the lipidic core; (iii) the thickness of the fibrous cup; (iv) the inflammatory infiltrate; (v) the degree of calcification; (vi) the intraplaque hemorrhage. Otherwise, statistically significant difference was found in microvascular density, in the number of CD68-positive macrophages and tryptase-positive mast cells in plaques from symptomatic patients, as compared to asymptomatic patients. Overall, this study indicate that although advanced symptomatic and asymptomatic carotid plaques present similar histomorphological characteristics, the degree of macrophage and mast cell infiltration and differences in microvascular density could help to discriminate between symptomatic and asymptomatic patients.

A case of neonatal intrapericardial teratoma. Clinical and pathological findings.

AIM: It is of general agreement that complete surgical removal after birth of intrapericardial fetal teratomas is needed, because of the risk of severe cardiovascular and respiratory distress, related to the mass size, location and secondary pericardial effusion. Histological examination generally shows mature aspect of cells and tissues. METHODS: We present a case of grade II immature pericardial teratoma, diagnosed in utero and completely removed after birth. RESULTS: Even surgical removal was complete, histological aspects raised the need of long follow-up with serial alpha-fetoprotein determinations. CONCLUSION: A neonatal grade II immature pericardial teratoma was completely removed after birth. The follow-up of the patient, until 10 months of life, was good with no recurrence of the disease.

Vessel probe CT protocol in the study of esophageal carcinoma: can it improve preoperative T staging?

AIMS: This study aims to compare transverse images and vessel probe (VP) in MPR mode reconstructions obtained by 16-row MDCT with the histological findings in the preoperative T staging of esophageal cancer. MATERIALS AND METHODS: Thirty-one patients (23 M, 8 F, mean age 63.2) with endoscopic and histological diagnosis of esophageal carcinoma underwent CT examination. Esophageal lumen was distended by CO2 and a biphasic technique with 35 s and 70 s delay was used after intravenous injection of contrast material. Transverse and VP in MPR mode images were evaluated and the following parameters were considered: presence and location of the tumor; esophageal wall thickness and enhancement; depth of visceral wall invasion; periesophageal fat morphology and infiltration of adjacent organs. Preoperative staging was performed and then it was compared with the histological findings considered as reference standard. RESULTS: Sensibility, negative predictive and accuracy values were 67%, 64% and 79% by using axial images for preoperative T staging, while the use of VP increased the previous values up to 83%, 78% and 89%, respectively. CONCLUSIONS: In the preoperative staging of esophageal cancer, VP in MPR mode reconstructions obtained by 16-row MDCT increase the sensibility and diagnostic accuracy values in the T parameter evaluation compared with axial images.

Preoperative T staging of gastric carcinoma obtained by MDCT vessel probe reconstructions and correlations with histological findings.

This study aims to evaluate the diagnostic accuracy of 16-row multidetector CT (MDCT) and vessel probe reconstructions in the T staging of gastric carcinoma. Fifty-three patients (39 men, 14 women, mean age 57.5) with an endoscopic diagnosis of gastric adenocarcinoma underwent CT examination. A hypotonic drug was administered, and the gastric walls were distended by the ingestion of 400-600 ml of water. A biphasic technique with 40-s and 70-s delay was used after endovenous contrast material injection. All patients underwent surgery, and preoperative and histological stagings were compared. The diagnostic accuracy of T staging was 68% for axial images and 94% for VP reconstructions. In the T1, T2, T3 and T4 parameter evaluation, diagnostic accuracy values were 87%, 73.5%, 81% and 96%, respectively, for axial images and 96%, 96%, 98% and 100%, respectively for VP reconstructions. MDCT is an accurate technique for the preoperative staging of gastric cancer. The VP reconstructions obtained by isotropic data can evaluate the T parameter with a higher accuracy.

Neurofunctional effects in rats prenatally exposed to fluoxetine.

In the treatment of depression fluoxetine [a selective serotonine reuptake inhibitor (SSRIs)] is a widely used drug in humans. The selectivity, efficacy, side effects and simplicity of dosage contributed to fluoxetine's clinical acceptance. Several psychiatric disorders (many of them responsive to SSRIs) are present during pregnancy; up to 10% of pregnant women fulfill diagnostic criteria for major or minor depression with an even higher percentage developing postpartum depression. Therefore, significant numbers of women may be taking SSRIs while pregnant. Since fluoxetine's safe use during pregnancy is not yet established and experimental studies inconclusive, we performed the present research in order to investigate the neurobehavioral effects produced in rats by prenatal exposure to fluoxetine (5 and 10 mg/kg/sc from day 13 to 20 of gestation) on cognitive functions, emotional reactivity and sexual performance.

Erythropoietin/erythropoietin-receptor system is involved in angiogenesis in human hepatocellular carcinoma.

AIMS: To correlate microvascular density and erythropoietin (Epo)/Epo-receptor (EpoR) expression in endothelial and tumour cells with histopathological type in hepatocellular carcinoma (HCC). METHODS AND RESULTS: Specimens of primary HCC obtained from 50 patients who had undergone curative hepatectomy were investigated immunohistochemically by using anti-CD31, anti-Epo and anti-EpoR antibodies. Poorly differentiated HCC had a higher degree of vascularization than other stages and Epo/EpoR expression in both tumour and endothelial cells increased in parallel with grade of malignancy and was highly correlated with the extent of angiogenesis. CONCLUSIONS: Epo/EpoR levels correlate with angiogenesis and progression of patients with HCC and these findings suggest the presence of a loop in the Epo/EpoR system, i.e. Epo is secreted by hepatic tumour cells and it affects vascular endothelial cells via its receptors and promotes angiogenesis in a paracrine manner. It is thus suggested that Epo is an important factor in hepatic tumour angiogenesis. Understanding the mechanisms of HCC angiogenesis provides a basis for a rational approach to the development of antiangiogenic therapy in patients with hepatic cancer.

Trend in thyroid carcinoma size, age at diagnosis, and histology in a retrospective study of 500 cases diagnosed over 20 years.

Recently, the Italian Network of Cancer Registries analyzed 5101 cases of thyroid carcinoma showing a reduction of mortality rate of 4%/year. This prompts us to evaluate the temporal trend in tumor size, age at diagnosis, and histology in a retrospective analysis of 500 thyroid cancers diagnosed over 20 years. Thyroid cancers were divided in two groups. The first included 193 cases diagnosed from 1985 to 1994, and the second 307 from 1995 to 2004. The size of all tumors was significantly reduced from 30 +/- 1.4mm in the first group to 15 +/- 0.8mm in the second group. In particular, papillary thyroid carcinoma (PTC) size decreased from 28 +/- 1.2mm to 14 +/- 0.8mm and follicular carcinoma from 40 +/- 6.3mm to 17 +/- 4.5 mm. Age at diagnosis of all carcinomas increased significantly from 40 +/- 1.3 years in the first group to 48 +/- 0.9 years in the second group. Analysis of the histological types revealed a significant increase of PTC rate in the second decade from 82% to 92% and a concomitant reduction of anaplastic thyroid carcinoma (ATC) from 3.7% to 1.0%. Moreover, a significant increase of micro-PTC rate, from 7.3% to 36.4%, was observed. In conclusion, it may be speculated that the above mentioned decreased mortality rate for thyroid carcinoma could be related to the significant reduction with time of cancer size, to the progressive increase of PTC rate and to the reduction of ATC rate. These data, if confirmed in other series, underscore the importance of evaluating thyroid nodules smaller than 10mm and corroborate recent findings suggesting that age be reconsidered as an independent prognostic factor for differentiated thyroid cancers.

Differential expression of the components of the plasminogen activating system in human thyroid tumour derived cell lines and papillary carcinomas.

We characterised the expression of the plasminogen activators (uPA and tPA), the uPA receptor (uPAR) and the PAs inhibitors (PAI-1 and PAI-2) in human thyroid cell lines derived from normal thyroid, follicular adenoma, follicular, papillary and anaplastic carcinomas. Urokinase PA activity was detected in the supernatant of normal thyrocytes and augmented in those of all tumour cells. Quantitative RT-PCR analysis showed that uPA, uPAR and PAI-1 mRNAs increased in all carcinoma cells. Similar results were found in 13 papillary thyroid carcinoma (PTC) tissues which were mirrored in Western blot experiments. A correlation was found between tumour size and uPA mRNA increase, and higher levels of uPA and uPAR mRNAs were found in metastatic PTC. In conclusion, thyroid carcinoma cell lines and PTC overexpress uPA, uPAR and PAI-1 and the correlation of uPA and its cognate receptor with tumour size and metastasis may suggest their potential prognostic relevance in thyroid cancer.

Comparative genomic hybridisation in malignant deciduoid mesothelioma.

BACKGROUND: Malignant deciduoid mesothelioma is a rare variant of epithelioid mesothelioma. This tumour generally has poor prognosis, and can be asbestos related. AIM: To identify peculiar genetic changes responsible for critical phases in pathogenesis of malignant deciduoid mesothelioma and their prognostic relevance. METHODS: Comparative genomic hybridisation was carried out in six cases of malignant pleural deciduoid mesothelioma, four sporadic and two familial. All cases were found to be asbestos related. Four patients died during follow-up and the mean survival was 29.5 (SD 14.2, range 12-43) months. RESULTS: Genetic abnormalities were found in all the tumour tissues, the most frequent being chromosomal gains at 1p, 12q, 17, 8q, 19 and 20 and losses at 13q, 6q and 9p. Survival was found to be longer in those patients who presented a smaller number of losses (< or =2) in the tumorous chromosomes. CONCLUSIONS: Although numerous genetic changes are presented by deciduoid mesotheliomas, certain chromosomal regions are preferentially affected. The clinical outcome for this mesothelioma subtype is predicted by the number of losses.

Confocal laser scanning microscope study of terminal villi vessels in normal term and pre-eclamptic placentas.

The aim of this study was to compare immunocytochemical confocal scanning laser microscopy measures of villus capillarization in control placentas with pre-eclamptic ones. Accordingly, placentas from normal term pregnancies (n=3) and cases of late-onset pre-eclampsia without intrauterine growth retardation (IUGR) featuring normal uterine artery Doppler (n=3) were analyzed by confocal scanning laser microscopy (CSLM), which is a powerful technique for obtaining three-dimensional reconstructions of any kind of blood vessels (arteries, veins, capillaries). A laser light beam is used in order to detect CD34 antibody-related immunofluorescence, which is a marker of endothelial cells. Villus capillarization was assessed by estimating the following parameters: number of pixels, mean, maximum and minimum immunofluorescence amplitude. Our results show a significant hyper-ramification of the capillary loop in pre-eclamptic placentas, featuring irregular profile and narrow lumina. Such findings support the hypothesis that several agents causing angiogenesis and vasoconstriction affect villus vessels in pre-eclamptic placentas, thus promoting a lasting condition of fetal hypoxia by decreasing endothelial surface and materno-fetal exchanges.

Primary intimal sarcoma of the thoracic aorta.

Primary aortic tumors are well known for both their rarity and variability in clinical presentation and usually are diagnosized post-operatively or by post-mortem examination. Intimal sarcoma is a recurrent histological variant and the involvement of the thoracic aorta is an unusual presentation. Angiography and computed tomography are accurate methods to evaluate aortic tumors though transesophageal echocardiography is actually used for the differential diagnosis. Here, we describe an unusual intimal sarcoma of the thoracic aorta whose clinical feature strongly mimicked a diffuse thrombotic disease.

Indomethacin-induced ileitis is associated with tensiometric, vascular and oxidative changes in the experimental rat model.

BACKGROUND: Indomethacin-induced enteritis is a model of inflammatory bowel disease. MATERIALS AND METHODS: To further characterize this model, rats received two injections of indomethacin (7.5 mg kg(-1)) 24 h apart and histological damage of intestinal mucosa, oxidative stress, alterations of intestinal motility and mesenteric vascular bed (MVB) reactivity were investigated after 5 days. RESULTS: The results show that indomethacin caused several histological and functional changes at the ileal level. In particular, response to carbachol as well as the nonadrenergic-noncholinergic inhibitory response to electrical field stimulation (EFS) was lower in the treated than control rats. Moreover, nitric oxide (NO)-component of the inhibitory response was higher in the treated than control rats. Mesenteric vessels preparations from the treated rats showed increased noradrenaline (NA)-induced perfusion pressure, whereas relaxant responses to acetylcholine, although not significantly reduced in the treated rats, had a higher nitrergic component. This finding suggests that vascular dysfunction may contribute to chronic inflammation. Indomethacin injection also determined acute and severe oxidative stress in ileum mucosa. CONCLUSIONS: In conclusion, our study contributes to further characterize the rat model of indomethacin-induced enteritis and suggests that it is suitable for drug screening in rats, as this model can be obtained in a very short period and is simple and reproducible.